Eligibility and Enrollment
Missouri WISEWOMAN Program Manual
Eligibility and Enrollment
Wisewoman Eligibility Requirements
- Age 40-64 years (*varies from SMHW)
- Uninsured or underinsured
- Low income (at or below 200% of federal poverty level)
- Unable to pay the premium to enroll in Medicare Part B
Income Requirements
SMHW/WISEWOMAN participants must have an income at or below 200% of the federal poverty income guidelines. Adjusted gross income on tax return or net amount on pay stub determines income eligibility.
SMHW/WISEWOMAN FY22 Income Requirements
| Household Size | SMHW Annual | SMHW Monthly | SMHW Weekly | SMHW Hourly |
|---|---|---|---|---|
| 1 | $25,760.00 | $2,147.00 | $495.00 | $12.38 |
| 2 | $34,840.00 | $2,903.00 | $670.00 | $16.75 |
| 3 | $43,920.00 | $3,660.00 | $845.00 | $21.12 |
| 4 | $53,000.00 | $4,417.00 | $1,019.00 | $25.48 |
| 5 | $62,080.00 | $5,173.00 | $1,194.00 | $29.85 |
| 6 | $71,160.00 | $5,930.00 | $1,368.00 | $34.21 |
| 7 | $80,240.00 | $6,687.00 | $1,543.00 | $38.58 |
| 8 | $89,320.00 | $7,443.00 | $1,718.00 | $42.94 |
| Each additional person, add: | $4,540.00 | $757.00 | $174.00 | $4.36 |
Insurance Requirements
SMHW/WISEWOMAN providers will use the SMHW/WISEWOMAN Participant Agreement Form (white) to document the insurance status of the participant.
Eligible Health Insurance Status
- No health insurance
- Health insurance does not cover services
- Participant states she is unable to pay deductible
- Have MO HealthNet with spend-down, but have not met spend-down
- Income eligible for Medicare Part B, but unable to pay premium
- Participants eligible to receive Medicare benefits, but not enrolled in Medicare should be encouraged to enroll
Ineligible Health Insurance Status
- Women with full MO HealthNet (ME Code 05), Adult Expansion Group (AEG) with ME Code E2, Medicare Part B, POS or HMO health coverage are not eligible for services
Participant Eligibility Guidance
Providers should develop plans to recruit SMHW participants into WISEWOMAN. Recruitment plans should reflect the following WISEWOMAN objectives:
- Serve as many eligible women as possible by using the most efficient means
- Reach populations that are at disproportionate risk for cardiovascular disease
WISEWOMAN Enrollment
Enrollment and participation in the WISEWOMAN Program is voluntary. WISEWOMAN participants must complete the SMHW/WISEWOMAN Participant Agreement Form (white), SMHW/WISEWOMAN Patient History Form (green) and must also be provided with the current DHSS Patient Privacy Rights Statement, in accordance with Health Insurance Portability and Accountability Act (HIPAA) regulations, prior to receiving services. The participant must also receive a HIPAA statement from the provider facility and retain proper documentation of this action. Current HIPAA regulations are located at the MDHSS website [NEEDS LINK]. After completing all required paperwork for enrollment, WISEWOMAN participants are eligible for an initial WISEWOMAN Screening Visit to complete Risk Reduction Counseling, followed by continued WISEWOMAN services.